P1412: CLINICIAN LED NUTRITIONAL ASSESSMENT AND PRE-OPTIMISATION OF PATIENTS UNDERGOING CAR-T CELL THERAPY
Authors: Olateni Awofisayo, Kathryn Riley, Nicola Scott, Danielle Brown, Sokar Legard, Mary Owen, Frances Seymour
Journal: HemaSphere (2023)

Topic: 25. Gene therapy, cellular immunotherapy and vaccination - Clinical Background: A challenge in delivering CAR-T therapy is ensuring patients maintain an adequate performance status in the setting of active malignancy, while CAR-T cells are being manufactured. This manufacturing time provides a valuable window of opportunity to optimize a patient’s physical status prior to infusion. Cancer and cancer therapy have an adverse impact on a patient’s nutritional status and consequently on their overall fitness. Patient’s undergoing CAR-T treatment have a fall in albumin, BMI and nutritional risk scores during their admission which may impact prognosis (Zhang 2002). CAR-T related toxicities place additional strain on a patient’s limited nutritional reserves, compounding the long term morbidity. Furthermore, current financial challenges in many health care settings mean that early specialist dietetic input is not feasible. Validated nutritional assessment tools can easily be implemented in a clinical setting but their use in the setting of CAR-T therapy has not been established. Aims: To establish the nutritional status of patients receiving CAR-T cell therapy and to evaluate the role of focused nutritional assessment and intervention. Methods: We developed a CAR-T nutritional assessment and intervention tool (nuCAR-T) that can be implemented by clinicians in the out-patient setting in order to guide optimization of nutritional status prior to CAR-T cell infusion. This tool combines objective measures of nutritional status, established nutritional scoring systems and patients reported symptom scores to stratify patients according to nutritional risk. Patients are offered a package of nutritional intervention according to their risk score, with interventions including dietary advice, nutritional supplementation and enteral feeding. We assessed the nutritional status of all CAR-T patients treated before and after implementing the nuCAR-T tool. In addition we assessed a cohort of patients who did not receive a CAR-T infusion either due to disease progression or inadequate performance status. Results: 40 patients who received CAR-T cell infusion were included in the analysis. A further 9 patients who didn’t ultimately receive a CAR-T infusion were also analyzed. Baseline characteristics are shown in table 1. At first visit, patients who went on to receive a CAR-T cell infusion had a lower LDH (241 vs. 551 p=<0.0001) and CRP (8.35 vs. 65 p=0.0063) and higher albumin (36 vs. 32 p=0.0029) and BMI (26.6 vs. 21.07 p=0.01272) than those who did not receive CAR-T cell infusion. At admission, patients managed on the nuCAR-T pathway had higher absolute albumin levels (36 vs. 32.5 p=0.0136), a reduced fall in albumin prior to admission (median fall 0 vs. 5 p=0.0001) and a higher proportion had a low risk MUST score (70% vs. 56.6%). 50% of patients on the nuCAR-T pathway gained weight prior to admission compared to 26% of patients on the pre nuCAR-T pathway. Patients managed on the nuCAR-T pathway had a median additional length of stay (beyond the mandatory inpatient stay) of 2 days, compared to 4 days prior to the nuCAR-T pathway. Interestingly, while CRS rates were similar between the cohorts, 90% of patients in the nuCAR-T group had ICANS 0 or 1 compared to 53.2% in the pre nuCAR-T group. Summary/Conclusion: Clinician led nutritional intervention can improve nutritional status for CAR-T patients at the time of infusion which may result in shorter duration of hospital admissions and reduced severity of neurological toxicity. Longer follow up across a larger cohort will be required to determine the impact of nutritional optimization on patient quality of life and overall treatment outcomes. Table 1:Keywords: CAR-T, Supportive care